Transcript Medical Imaging Solutions Western Cape Scenario Our current problems!  No comparison to previous films     Repeat examinations    Lost / Destroyed films and/or packets No post-processing (Throw-away: 38,000

Medical Imaging
Solutions
Western Cape Scenario
Our current problems!
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No comparison to previous films
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Repeat examinations
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Lost / Destroyed films and/or packets
No post-processing (Throw-away: 38,000 films/year at TBH)
Clerks, Radiographers and Doctors doing
administrative work
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Lost / Destroyed films and/or packets
Not all images are printed (MDCT 500 images/study; Print 20 images/sheet @
R20/sheet)
Rest of the images are deleted!
No integration between computer systems (Request form, Booking, Arrival, Tick
sheet, Modality/Examination entry and Report)
Plain film X-rays
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Dark room personnel, Chemicals, Film
Our current problems!
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Delays
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Storage
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Labor intensive, occupies space & problems (Lost reports, packets, films)
Poor communication with referring doctor
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Radiologist wait for request form, film to develop and the previous
imaging
Referring wait for new imaging and the radiologist report – dependant on
physical transport
Imaging not available at 2 places, no interaction
Radiology opinion limited
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Limited personnel in peripheral hospitals
The solution
GO
DIGITAL !
General Definitions
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PACS : Picture Archiving and Communication Systems
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DICOM : Digital Imaging & Communications in Medicine
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Administrative information
RIS : Radiological Information System
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An international format of medical images
HIS : Hospital Information System
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Image database
Radiology reports
Teleradiology
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Send medical images to other locations for evaluation
Workflow and System
Integration
HIS
RIS
Imaging
Modalities
Report Dictation
Radiology
Diagnostic
Workstations
Clinician
Viewing stations
PACS Server
Long-Term Storage
Distribution:
CD/DVD, Email,
Web
Server
Workstation
Modalities
CT : Already digital
Gamma camera :
Already digital
Mammography
Gamma
camera ::
Alreadydigital
digital
Already
MR : Already digital
Ultrasound :
Already digital
Plain film :
CR vs DR
Fluoroscopy :
Already digital
Vascular theatre :
Already digital
The Advantages
Workflow
 Patient care
 HR utilization
 Cash Flow
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 Teaching
 Administration
 Research
Improved Workflow
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Shorter waiting lists
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Shorter waiting periods (in radiology department)
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Increased productivity (8.2 pt/hr vs. 10.7pt/hr)
Less risk to patient health
Clerk, Radiographer, Doctor admin
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Increased productivity (8.2 pt/hr vs. 10.7pt/hr) = 20pts/day (8hrs)
No unnecessary repeat examinations
Eliminated through integration with HIS
Performing examination
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No significant change in duration
Repeat examinations due to technical factors eliminated through
post-processing
Retakes: Screen-film radiography 7%; Digital radiography 0.7%
Improved Workflow
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Finished examination till study available for viewing
 Shorter – uploaded into PACS (29.2min vs. 5.7min)
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Radiology reporting time
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Unchanged (more images viewed per session)
Report finished to report at clinician
 Shorter - available via RIS
Shorter Turnaround (total) time (26 hrs vs. 2 hrs)
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Clinician can view image immediately
Radiologist can start reporting sooner
Pt entering radiology department until Clinician has study and
radiology report available
Better Utilization (30% Inpatient, 60% Outpatient)
Improved Patient Care
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Quicker service
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No unnecessary repeat examinations (Radiation)
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Shorter waiting lists
Shorter waiting periods
No Lost / Destroyed films & packets
Post-processing improves quality
Improved comparison
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All (500) images are available & NOT lost, destroyed or deleted
Previous studies reviewed more frequently
(0.56 vs. 0.84 Historical images viewed /study)
All modalities available (Swallow, CxR & CT)
Reference library
Improved Patient Care
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Clinician decision making
Faster availability of images
 Reports are legible and faster available
 Interactive discussions, from remote locations
 Shorter hospital stay
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Patient referral from peripheral hospitals
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Questionable imaging can be clarified immediately,
preventing unnecessary patient referral (C-Spine)
After hours consultant opinion, easily available
from remote locations
Improved HR utilization
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Modality and discipline specialists (e.g. Nuclear medicine &
Pediatric radiology) can be consulted from any location
Consultants no longer station bound, and can assist
multiple stations
Improved workload distribution
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Peripheral hospitals can consult departments in real time
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Busy departments can share their workload
Choice of imaging or discussion of study findings
Central hospitals outreach to Regional hospitals (In
concordance with the 2010 vision)
Less demand on: Porters, Filing & Sorting personnel
Improved Cash Flow
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By eliminating plain film
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No repeated examinations
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Examinations lost
Poor technical quality
Income from teaching programs
Public – Private – Partnerships
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Film
Chemicals
Personnel : Dark room assistants
3T MRI (US)
Research funding
Improved Administration
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Statistical solutions via HIS
Patient profile
 Audit
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Productivity: Examinations performed
 Clinically: Procedure followed
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Accounting and Billing solutions via HIS
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ICD 10 coding solutions
Enhanced Teaching
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Interactive interdisciplinary meetings
Clinical : Patient management & decision making
 Academic : Teaching session
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Digital teaching library
Reference library
Teaching programs
Videoconferencing sessions
Enhanced Research
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Searchable archive
Provincial cooperation in research
Better follow-up on research cases
Improved statistics & archiving
 Involvement of referring hospitals
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Established centre of excellence
Return of Investment
Health imaging and IT, May 2004
Mercy Medical Center,
Des Moines
Tygerberg Hospital
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1300 beds
150,000 annual examinations
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Return on capital 5-7 years
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1000 beds
250,000 annual examinations
Kodak PACS, 2 years after
installation, 85% filmless
Reduction in staff: 15
Workload: 17% higher
Revenue per FTE: 40% higher
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Saving: $2Million
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Challenges
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IT
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PACS Training (Different levels of computer skills)
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Radiographers
Radiologists
Clinicians
Teething problems
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Upgrading of PGWC networks
Maintenance and support
TBH: Pilot program in place – DIY PACS
RXH: Limited PACS in operation
Communication between digital and non-digital hospitals
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Addressed by CD storage media
Expected cost
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IT Networks & Support
R 40 million (3 x Central Hospitals)
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R40 million (8 x Revitalization sites)
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Pretoria Academic Hosp: R18 million
UCT quote: R10 million
Worcester quote: R5 million
R 5 million per regional hospital
R 3 million per district hospital
R500,000 per community health centre
Approach to Provincial PACS
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Phase 1 – Short term
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Phase 2 – Medium term
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Academic hospitals
Revitalization sites
Phase 3 – Long term
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Equipment purchasing, should be done in line with provincial digital vision
Nuclear Medicine network
Other regional hospitals
Other district hospitals
Community Health clinics
Phase 4 – Visionary : Paperless hospitals
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Combination with Electronic Medical records & Emergency Services
Combination with Cardiology & Anesthetics
Combination with Pharmacy & Inventory
Conclusion
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Make the digital choice
A provincial vision on digital medical imaging is
vital
Collaboration with IT team is critical
A joint provincial venture makes sense
Pilot projects already exists
Implementing PACS : Filmless
Expanding PACS : Paperless
Request from TMM
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Approve in principal : Provincial PACS
Approve the formation of a technical team, with
a mandate to:
Develop a provincial digital medical imaging strategy
 Evaluate the implications
 Make recommendations
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Q&A
Demonstration
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CD
Laptop
The TBH Situation
Examinations done
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150 000 exams per year (2005)
9.9% CT & MRI
 74.1% Plain film
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Beds : 1295
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Discarded film : 38,000 per year
The TBH Situation
Costs incurred
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Film
Chemicals
X-Ray packets
US Paper
Personnel
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Dark room assistants (9)
Sorting & Filing personnel (?)
Porters (?)
Total:
R 1,513 640
R 254 026
R 34 266
R 25 542
R 350 796
R 2,178 270
Data Safety & Security
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Safety
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Compared to plain film?
No % guarantee that nothing will be lost
Several technical steps to ensure data integrity
Off-site storage
Security
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Compared to plain film? Or Internet banking?
No 100% guarantee that nothing will be hacked
Several technical steps to ensure data security
Data-encryption during transfer